F 144 
.fl8 R3 
Copy 1 




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il 



ATLANTIC CITY 



DDP. 



AS A 



Winter Health Resort, 



Embracing Official Reports, Meteorological Tables, &c.. 
Concerning the Climate of Atlantic City, N. J., the 
Testimony of Eminent Physicians as to its Ef- 
fects ON Various Formis of Disease, Hygienic 
Hints for Invalids at the Seashore, and 
Information about the Sanitary 
Condition of Atlantic City. 



BY BOARDMAN REED, M. D. 



Sfxond 1 



vDITION. 
\ 



\ 



philade 

ALLEN, LANE & SCOTT 
Nos. 229-231 Sou 



\, 



'.G HOUSE, 




ATUNTIC CITY 



AS A 



Winter Health Resort, 



Embracing Official Reports, Meteorological Tables, &c., 
Concerning the Climate of Atlantic City, N. J., the 
Testimony of Eminent Physicians as to its Ef- 
fects on Various Forms of Disease, Hygienic 
Hints for Invalids at the Seashore, and 
Information about the Sanitary 
Condition of Atlantic City. 



BY BOARDMAN REED, M. D. 



Second Edition. 



PHILADELPHIA: 

ALLEN, 'LANE & SCOTT'S PRINTING HOUSE, 

No. 22q-23i South Fifth Street. 



Exchange 

N. y. Pub. Lib. 

JUL 1& '90t> 



1 V 



A<^~K3 



PREFACE. 



THE reprint from the Philadelphia Medical Times of a paper 
on "The Climate of Atlantic City, and its Effects on Pul- 
monary Diseases " was sent last winter to numerous physicians in 
various parts of the United States. There have since been many 
requests for additional copies, which could not be furnished, the 
edition having been exhausted. It has been deemed advisable in 
preparing a second edition to include with this the principal part 
of a paper contributed by me to the New York Medical Jotirnal 
for March, 1881, entitled "-What Atlantic City can do for Con- 
sumptives; " also portions of an article contributed to the Phila- 
delphia Medical Bulletin for November, 1880, relating particularly 
to the hygienic precautions needed to be taken by invalids sojourn- 
ing at the seaside, and of a communication to the Philadelphia 
Medical and Surgical Reporter of July 9th, 1881, on "The Sani- 
tary Condition of our Seashore Health Resorts." 

A letter from Dr. William Pepper, Provost of the University of 
Pennsylvania, written in reply to a request from me for a statement 
of his experience in sending pulmonary cases to Atlantic City, was 
not received in time for insertion in the original paper, but is now 
printed for the first time. 

Another year's experience has been strongly corroborative of the 
views hitherto expressed by me as to the curative value of this 
climate at all seasons, but especially in the winter and spring. 
Last winter was much colder than the average, here as well as in 
Florida and all over the continent ; yet quite as much benefit as 
usual was derived by consumptives in the earlier stages. The same 
may be said of persons suffering with bronchial or throat affections. 
But perhaps the most marked improvement has been noted in cases 

3 



of nervous exhaustion in all its protean forms, and of chronic 
malaria. These have almost uniformly gained rapidly and steadily 
here under proper hygienic conditions. 

Testimony has been gathered with regard to the effect of this 
climate upon lung diseases especially, because, while it is generally 
admitted that sea air is highly curative in nearly the entire list of 
chronic ailments, there has been a widely-prevalent impression, 
both among the laity and medical profession, that consumptives 
are always better away from it. This impression is now known to 
be erroneous, it having been demonstrated by abundant clinical 
experience that phthisis in its earlier stages is no exception to the 
rule that all the morbid results of weakness and impaired nutrition, 
when not too far advanced, may hope for improvement from the 
tonic and alterative effects of a dry and stimulating sea air. This 
fact has been well attested in Europe, and is confirmed in the fol- 
lowing pages by the testimony of a few of the many physicians 
who have long been sending consumptives to Atlantic City. 

B. R. 
Atlantic City, N. J., November 15th, 18S1. 



ATLANTIC CITY 

AS A 

WINTER HEALTH RESORT. 



SOME years ago it occurred to me that there was need of exact 
and reliable facts concerning the climate of Atlantic City. 
With a view to obtaining such facts I began making regular obser- 
vations of the weather at my office, noting the temperature, relative 
humidity, direction of the wind, and condition of the sky, four times 
daily. This was kept up for about one year. Afterwards, finding 
that my instruments were inferior in accuracy to those at the United 
States Signal Station in another part of the town, I arranged with 
the observer there to furnish me with any information desired. 

Furthermore, in order to determine as definitely as possible the 
benefit to be derived from the climate by various classes of invalids, 
and especially by persons afflicted with pulmonary complaints, I 
addressed inquiries to many eminent physicians who had been in 
the habit of sending patients to Atlantic City in the winter and 
spring as well as in the summer, asking them to report the number 
of cases sent here, the proportion cured or benefited, the propor- 
tion aggravated if any, and the proportion which had remained 
stationary. 

The replies were not in point of fullness all I had hoped to obtain, 
but, together with the meteorological data previously accumulated, 
they were given to the profession in an article first published in the 
Philadelphia Medical Times, for December iSth, 1880, and entitled 
"Winter Health Resorts ; The climate of Atlantic City and its effects 
on Pulmonary Diseases." 

That article is here reproduced as follows : — 

" Where shall we send our invalids for a change of air in winter? 
This is a practical question which is becoming, year by year, more 
important to busy physicians, particularly in the great cities of the 
North. There are certain chronic diseases for which a pure and 
invigorating air, and especially a climate which will tempt the pa- 
tients out of doors, are highly desirable. For many cases a 

5 



change to such an air offers the best hope of cure, or even of ameli- 
oration. 

''Florida has been much in vogue lately as a winter-resort, and 
undoubtedly suits numerous patients well ; but it is too far away, in- 
volving a long and tiresome journey. The distance from home and 
friends, and the impossibility of conferring in an emergency with 
the usual medical attendant, are serious inconveniences. The 
prevalence of malaria there is a source of danger, and the very 
warm and enervating character of the Southern climate unfits it for 
a large class of diseases altogether. 

" Colorado and Minnesota are even farther away, and their 
climates, however tonic and useful, are so cold that invalids there 
can live very little out of doors during the winter ; and if they are 
to be kept prisoners in close heated rooms it might almost as well be 
in their own homes. 

" Northern Africa and Southern Europe, especially Pau, Nice, 
Mentone, and other places along the northern shore of the Medi- 
terranean, are just now in great repute. IiTvalids are flocking 
thither every winter, and, the impartial chroniclers tell us, are 
leaving their bones in the cemeteries there in sadly large numbers. 

"Dr. Madden, in his 'Health-Resorts of Europe and Africa,' 
says: — 'With one exception the most frequented winter health- 
resort in Europe is Pau;' then proceeds to denounce the climate 
as 'essentially cold, variable, damp, and dreary during the winter.' 
During one December while he was there he states that ' the 
thermometer/^// eleven tiines to zero.'' 

" Dr. John Parkiii, in his work on ' Climate and Phthisis,' is 
equally emphatic in condemning that climate, saying, among other 
things, that ' of a number of patients I have known who passed a 
winter in Pau, not one received any benefit— the majority died 
soon after their return.' 

"As to Nice and Mentone, Dr. Madden quotes several medical 
travelers and former resident physicians to the effect that these 
places are exposed to very sudden changes of temperature, and 
that the native residents are very subject to pulmonary complaints, 
which with them are apt to run a rapid course. Dr. Parkin, in 
the work already quoted, is particularly severe upon the climate 
of those places, stating that though it is usually very warm there 
in the sun, insomuch that umbrellas are indispensable, it is apt to 
be cold in the shade, necessitating the heaviest wraps. Crossing the 
street is like passing from summer to winter. The same author 
shows that, from the location of these towns in the neighborhood 
of mountains, some of whose tops are always covered with snow 
in winter, theymust be continually subject to cold, raw winds, which 
are all the more intolerable and dangerous because of the heated 
air which they displace. 

" Says Dr. Parkin : — ' During January and February, then, there 



would be two cold winds prevailing at Mentone, as is frequently 
the case at Nice. It is not surprising, therefore, that I should have 
left the latter town in the month of March in a snow-storm, or that 
snow should have fallen heavily all the way to Genoa.' 

"Dr. J. H. Bennett, of Mentone, the chief eulogist of that cli- 
mate, insists very strenuously upon certain precautions against 
taking cold. ' Without them,' he says, ' it is unsafe and treacher- 
ous. This is evidenced by the great mortality of the natives of the 
Nice and Mentone districts by pneumonia and pleurisy, two of the 
commonest maladies.' 

" Dr. Parkin's conclusion is that the Riviera is ' one of the most 
unfavorable and dangerous climates for chronic diseases of the respi- 
ratory organs, and especially for phthisis.' As to Africa, he cites 
army reports showing that ' of the British troops passing through 
Egypt during 1872 en route for India, 29.9 per 1000 were at- 
tacked with phthisis, and 2.3 per 1000 died.' He ' adds, 
* When it is remembered that these patients manifested no 
symptoms of the disease when they left England, otherwise they 
would have been detained, this result speaks trumpet-tongued as re- 
gards the influence of such a climate in the development of 
phthisis. ' 

" If these are the most desirable winter-resorts in the Old World, 
American invalids, especially those suffering from chronic pulmo- 
nary affections, would do well to remain on this side of the ocean. 

"Atlantic City, New Jersey, a place most^favorably located as re- 
gards convenience of access, being ninety minutes' ride from Phila- 
delphia by the West Jersey Railroad, and only four hours from 
New York by the Pennsylvania Railroad and its West Jersey branch 
line, possesses certain physical advantages which are well worth 
considering. It has been twenty years or more since physicians be- 
gan sending patients here in winter. First only now and then a 
courageous invalid ventured here at this season, but their numbers 
steadily increased. The experiment proved so successful in hasten- 
ing the convalescence from acute disease, in improving a large class 
of chronic affections, and especially in arresting numerous cases of 
incipient as well as confirmed consumption, that within the last 
three years the travel to the place in winter has reached very con- 
siderable proportions, and the numerous thoroughly-heated winter 
hotels — some of which are as sumptuously furnished and as luxuri- 
ously conducted as the leading houses at the summer-resorts — are 
crowded with invalids, convalescents, and wearied society people 
through all the months from January on. 

"Actual experience has demonstrated that sea air is as valuable in 
winter as in summer. It also bears out the statistics which prove 
that the climate of Atlantic City is superior to that of most sea-coast 
towns, being drier, more equable, and, considering the latitude, un- 
usually mild. 



8 

"The city — for it is in fact as well as in name a city, having a 
permanent population of six thousand, and being supplied with gas, 
street-cars, &c. — is situated in latitude 39° 22', on an island ten 
miles long and averaging about half a mile wide. This is separated 
from the mainland at either end by broad bays or inlets, which are 
connected by a narrow arm of the sea called 'The Thoroughfare,' 
There is no body of fresh water nearer than the Delaware river, 
distant about sixty miles, and the salt-water bays to the landward 
side are nearly always open, ice seldom forming, except for a short 
time occasionally in the severest winters. 

" Another peculiarity of the location is that all the winds from the 
landward must pass for long distances — hundreds of miles in some 
directions — over a very dry and porous sandy soil upon which snow 
rarely lies for any time. These winds, including those from the 
north, north-west, west, and south-west, are therefore to some extent 
both dried and warmed in their passage. 

"INFLUENCE OF THE GULF STREAM. 

"Though the coast of Southern New Jersey has a general direc- 
tion from north-east to south-west, the beach at Atlantic City trends 
more to the westward, so that it faces almost directly southward. 
Therefore south as well as east winds are sea breezes here, and both 
blow across the Gulf Stream, which, by the way, exercises consider- 
able influence upon the climate of this part of the coast. 

" Mr. C. P. Patterson, Superintendent of the United States Coast 
and Geodetic Survey Office at Washington has kindly furnished me 
with a large map indicating accurately the course of the Gulf 
Stream, and with some interesting facts concerning it. 

" This map shows at a glance that the heated waters of the tropics, 
pouring through the space between Cuba and Florida, flow in a 
north-easterly direction along the coast of Georgia and theCarolinas, 
diffusing themselves as they go, until from a compact stream less 
than fifty miles wide, they have become opposite Chesapeake Bay a 
broad expanse upwards of four hundred miles in width. This really 
includes numerous parallel or slightly diverging currents of very 
warm water with overflow currents of a somewhat lower tempera- 
ture. One of these overflow currents approaches within sixty-iive 
miles of Atlantic City, while it is one hundred and ten miles from 
Sandy Hook. The principal current is farther away, being one 
hundred and thirty-five miles from Atlantic City, one hundred and 
eighty-five miles from Sandy Hook, and about the same distance 
from Long Branch and Montauk Point. 

" But the exceptional mildness of this climate may be attributed 
to the peculiar course of the Gulf Stream in this vicinity as much as 
to its proximity. The innermost current, according to the map re- 
ceived from the Coast Survey office, has a direction opposite At- 
lantic City of east-north-east, but turns more and more to the east- 
ward till in latitude 40° — that of Philadelphia — it bears nearly due 



east. The main current turns more abruptly, and a little north of 
latitude 38°, some distance to the southward of Atlantic City, has 
a course directly eastward. Our south, south-east, and east winds, 
then, must all pass for three hundred to five hundred miles at least 
over more or less heated water which has come directly from the 
Gulf of Mexico. Our only ocean breezes not affected m this way 
are those from the north-east, and experience shows that these are 
the only winds which are generally unpleasant here. But for places 
farther up the coast, particularly those north of latitude 40 , the 
case is different. Neither their north-east nor east winds can be ap- 
preciably modified by the Gulf Stream. Their south and south-east 
winds may be favorably influenced to some extent, but less than are 
the same winds at Atlantic City, since they pass over a much larger 
surface of cold water after crossing the Gulf Stream. It may be 
added that some small maps issued by the Signal Service office repre- 
sent the Gulf Stream as occupying different positions m winter and 
summer, but on this point Mr. Patterson writes, ' I greatly doubt it 
there can be any material change of the stream from season to 
season ; at least there has been no reliable evidence obtained on 
that subject.' 

METEOROLOGICAL STATISTICS. 
" To Sergeant E. W. McGann, who has charge of the United 
States Signal Station at Atlantic City, I am indebted for meteor- 
ological statistics and official records, from which the following in- 
formation, bearing directly upon the subject of the climate of the 
place, has been condensed and tabulated : — 

Temperature, Humidity, Barometrical Pressure, and Rainfall at 
Atlantic City, New Jersey. 



Months, 1880. 



Mean temper- Range of tern- 
ature. perature. 



Mean humid- 
ity. 



Mean ha- 1 Rainfall, in 
rometer. i inches. 



January, 
February, 
March, . 



41. 1 
38.2 
40.1 



Min. 

13 

II 
18 



79-3 
74-4 
71.9 



30.1B9 
30.129 
30.061 



1.70 
2.85 
5 97 



39-8 



30.126 



Mean for three months. 

"The mean temperature f^TTanuaryrFebruary, March, and De- 
cember, the four coldest months of the year, was, m 1879, 34-7 5 

in 1878, 36.8°; and in 1877, 35-9°- , r .1, f o^ri 

- The prevailing winds in winter are those from the west and 
north-west, which are usually dry and bracing. The east and south 
winds, which often blow for days at a time, are warmer and rnore 
humid North-east winds, which are unpleasant, usually prevail for 



two or three days at the time of the equinoctial storms, but are in- 
frequent during the remainder of the year. 

" Observations taken at my office, in the centre of the town, at 
7 A. M., 12 M., and 6 and lo p. m., show that in December, 1879, 
there were twenty-six days during which the tliermometer did not 
fall below 32° — the freezing point; also that there were only two 
days in the same month when the thermometer did not indicate at 
noon a temperature above 40°; and that there were ten days upon 
which it was not below 50° at the same hour. During the January 
following (1880) there were twenty-four days during which the 
mercury never fell below the freezing point at any hour, and only 
two days during which it went below 30°. It was only once in the 
same month lower than 40° at noon, and only three times lower 
than 45° at the same hour. On nineteen of the thirty-one days the 
thermometer stood at 50° or above at mid-day. 

" These mid-day temperatures are obviously more important than 
averages, for it is in the daytime that invalids take their airing out 
of doors. 

" The dryness of this climate, as compared with other seaside 
resorts, is best shown by the statistics of the rainfall, which is less 
here than at any other place on the coast, as appears from the table 
given below. The readings of the hygrometers at the different sta- 
tions are not so significant, since at some of them, including At- 
lantic City, the instruments are located so near to the beach, and 
at so low an elevation above the sea-level ( less than thirteen feet 
here), as to be affected by the spray, during strong winds off the 
water, and by occasional morning mists, which do not extend back 
into the town.* 

Annual Amount of Rainfall at the Principal Cities and Stations 
en the Atlantic Coast. 



Stations. 



Year ended 
June 30th, 1879. 



Year ended 
June 30th, 187I 



Atlantic City, N. J., 40.60 inches. 

Barnegat, N. J., 49-38 " 

Boston, Mass., 62.96 " 

Cape May, N. J., 42-44 

Charleston, S. C, 64.33 " 

Galveston, Texas, 51-03 " 

Jacksonville, Fla., 51-62 " 

Newport, R. I. 52.20 " 

New Orleans, La., . . 58.29 " 

New York, N. Y., 43.68 " 

Norfolk, Va., 44-44 " 

Portland, Me., . 41.10 " 

Sandy Hook, N. J., : 60.37 

Savannah, Ga S5-I4 " 

Wilmington, N. C , 1 50.90 " 



.90 inches. 
•35 " 



* Since the foregoing was published, it has been ascertained from the records of the signal 
station here that there is greatly less wind at Atlantic City than at most points on the coast. 
For instance, the whole movement of the wind during the year 1879 was 84,117 miles at Atlantic 
City, 109,059 miles at Barnegat, and 135,883 miles at Cape May. 

Thus at the neighboring stations on either side of this place there are, on the average, much 
higher winds. 



II 

" The mean barometer for the year ended June 30th, 1879, was 
higher at the Atlantic City station than at any other on the coast 
north of Chesapeake Bay, and, with one or two exceptions, the 
same may be said as to the preceding year. This is a matter of im- 
portance, since depressions of the barometer affect the majority of 
invalids far more decidedly and injuriously than low temperatures. 
An extra wrap out of doors, or a fire in-doors, will perfectly anti- 
dote any ordinary degree of cold, but it is far more difficult to ren- 
der comfortable the invalid whose breathing is distressed or whose 
joints and nerves have been set to aching by a sudden fall in the 
atmospheric pressure. Barometrical changes are also connected in- 
timately with variations in the electrical conditions of the atmos- 
phere, and these again strongly impress the delicate nervous sys- 
tems of the sick. 

*'In the following table the figures represent the average atmos- 
pheric pressure for the years named at the sea-level, allowances hav- 
ing been made for differences in the elevation of the stations : — 

Table Showing Mean Barometer at Various Stations. 



Year ended Year ended 

June 30th, 1879. June 30th, 187 



Atlantic City, 30.031 30.002 

Bamegat, 30.029 29.998 

Boston, 29.975 29.969 

Cape May, 30.029 ' 30.007 

Galveston, 30.049 29-995 

Jacksonville, 30.079 30.030 

Newport, 29.993 29.980 

New York, 30.026 30.006 

Portland, Me. 29-944 ! 29.952 

Sandy Hook, 30.014 I 30.C00 

"After all, however, it is with climates as with medicines, — 

trustworthy evidence as to what they have accomplished is the most 
valuable. With regard to nervous, rheumatic, gouty, dyspeptic, 
and various other chronic ailments (including most of those pecu- 
liar to women), which are usually found to be benefited here in the 
summer, equal benefit may be expected in the winter. Convales- 
cents from acute disease, or from surgical operations, nearly always 
improve remarkably upon being removed to this place from the 
large cities. 
' "As to diseases of the respiratory organs, I have had personal 
knowledge of many patients suffering from various forms of such 
affections who have made trials of this climate in winter. The 
bronchial and laryngeal cases have, as a rule, improved, some of 
them very decidedly, though there have been exceptions. The con- 
sumptives who were in the third stage, or in any stage with evi- 
dences of actively progressing disease of the lung and decided 



hectic, have only exceptionally been benefited. Those, however, 
in the pretubercular or incipient stage, and those even in the ad- 
vanced stages where the destructive process has been advancing 
slowly, have often experienced very marked improvement. In a 
considerable proportion — about one-fourth — of the cases of these 
latter classes, the disease has been apparently arrested, and some of 
them seem to be cured. 

'' Detailed reports of the cases I have treated at Atlantic City' 
would fully bear out the foregoing general conclusions, but would 
unduly extend this paper and necessitate the exclusion of several 
reports I have received from prominent Philadelphia physicians 
concerning the effect of this climate upon their patients, in winter 
especially. Some of these physicians have been sending patients 
hither for more than twenty years. Their testimony is more valua- 
ble than mine, and can not be impugned on the ground of partiality. 

" It is a significant fact that pneumonia and bronchitis are of 
infreqnent origin here, and when they do occur the patients almost 
invariably recover-. Upon this point my experience as a resident 
physician enables me to speak very positively. I have not known 
an uncomplicated attack of either disease to prove fatal. 



REPORTS FROM PHYSICIANS. 

" The reports from physicians above referred to were received in 
response to inquiries recently sent to them. Many others wrote 
brief apologies, not having the notes or the leisure to tabulate the 
results of their experience as I had requested. Only one physician 
objected to the climate either for bronchitis or early phthisis. 

"Dr. Laurence Turnbull writes; 'The number of cases of 
phthisis that I have sent to Atlantic City have been few iri the last 
stages, as I found they were not improved by a residence at the sea- 
shore, dry even as it is,' adding that a few cases in those stages 
were aggravated, but goes on to say, ' I have been much pleased 
with its influence on the first stages of phthisis, asthma, laryngitis, 
bronchitis, and nasal catarrh, when all ordinary means have failed 
in the city, by causing improvement in the appetite, assisting the 
digestion, and giving a healthier tone to the skin. In convales- 
cence from catarrhal pneumonia and typhoid fever the results have 
been most gratifying. In certain forms of otitis media purulenta J 
do not find the air of Atlantic very beneficial, and in many cases 
diseases of the ear are caused by exposure of that organ to the waves. 
In strumous diseases of eyes, joints, limbs, &c., I have found the 
change to Atlantic City, if persisted in for several seasons, of per- 
manent benefit.' 

" Dr. Thomas J. Yarrow writes : ' It has not been my practice, 
as a rule, to advise patients suffering with tuberculous and other 



13 

diseases of the respiratory passages to sojourn at the seaside. Ex- 
ceptionally, I have had them go to Atlantic City, and have known 
cases of incipient phthisis, chronic bronchitis, asthma, and laryngitis 
to improve in that location. My experience of late is inducing me 
to recommend a larger number of such cases to reside at Atlantic 
City.' 

' ' Dr. Thomas G. Morton thus bears testimony : ' I have been in 
the habit of sending to the shore at Atlantic City many patients, 
more especially surgical cases, but a large number also of those with 
lung affections, and especially those having a (hereditary) tubercular 
disposition, and I think especially such cases have been vastly ben- 
efited by the sojourn.' 

"Dr. James Darrach, of Germantown, writes: 'Have sent sev- 
eral cases of autumnal catarrh to Atlantic City, and think without 
exception they were benefited, two of them being certainly exempt 
from these attacks while at the shore. The only case of slow con- 
valescence from pneumonia died at Atlantic City. This was about 
twenty-three years ago. A case of obstinate general bronchitis was 
cured in about ten days. A case of what I supposed to be tuber- 
cular laryngitis was very much benefited, and subsequently recov- 
ered. I have also had other cases of obstinate catarrh which re- 
turned well after a sojourn at Atlantic City.' 

" Dr. Eugene P. Bernardy reports as follows : ' With but one ex- 
ception, all my cases of phthisis, both in the early and late stages, 
amounting to twelve in all, have been decidedly benefited by a 
sojourn at Atlantic City, and one case positively cured, — that is, as 
far as human ear can ascertain. Of the three cases of convalescence 
from pneumonia all were decidedly benefited. In a child suffering 
from chronic pneumonia the lung in a few weeks was almost entirely 
cleared up. In bronchial affections (chronic) I have seen no per- 
manent benefit in any of the six cases I have sent there ; all bene- 
fited while at the seashore, but a few months after their return 
relapsed. The case of phthisis cured had been examined by myself 
and Dr. Hall in Philadelphia, and while at the seashore examined 
by Dr. L. Turnbull. We all diagnosed incipient phthisis. This 
was nearly six years ago. On her return she had gained forty 
pounds, and has remained well ever since.' 

"Dr. John H. Packard says, referring to Atlantic City, 'I can 
only say that I frequently advise convalescents to go there, and that 
it is a very common thing with me to be asked by patients whether 
it would not do them good to spend a week or two there. I do not 
now recollect any case that has been wholly without benefit from 
that climate, and could adduce many that have gained great advan- 
tage from it.' 

"Dr. D. Murray Cheston writes : ' I can not say how many cases 
of pulmonary or bronchial troubles I have sent there, but the gen- 
eral result has been most satisfactory. The cases were all sent in the 



14 

late winter or early spring months, and have invariably returned 
improved.' 

"Prof. J. M. Da Costa writes briefly, as follows: 'I have sent 
too few patients with pulmonary disease to Atlantic City to have the 
data to answer your questions. Some who were in a run-down con- 
dition and affected with chronic bronchial catarrh did very well.' 

" Dr. Ellwood Wilson writes that in the summer months he does 
not think patients with fully-developed phthisis improve by a pro- 
tracted residence at Atlantic City, but adds, ' During the winter 
months — say from October to July — I regard it as a very favorable 
locality for consumptive patients.' 

"Dr. R. J, Levis writes that his practice (being almost exclu- 
sively surgical) ' is not of a kind to furnish experience with regard 
to the beneficial influence of Atlantic City in pulmonary affections,' 
but that he has ' a good opinion of its dry and mild climate.' 

" Dr. James J. Levick has not sent any cases of phthisis, but has 
sent ' several cases of laryngeal and bronchial irritation and one or 
two cases of hay asthma, which improved greatly while at Atlantic 
City.' He adds, * The cases which have derived most benefit, 
however, and of which I have sent not a few in the late winter 
months, have been patients after typhoid fever, — patients whose 
nervous systems have been much disturbed, persons who have needed 
brain rest, &c.' 

"Dr. William H. Bennett, resident physician at the Children's 
Seashore House and Seaside House for Invalid Women at Atlantic 
City, contributes the following full report : ' My experience of the 
effects of a sojourn at Atlantic City upon those suffering from pul- 
monary diseases has been confined to what I have seen among 
transient visitors during the summer months of the past seven years. 
I have had little or no experience of the effects either of a pro- 
longed stay or of a stay in winter. I can not give you exact figures, 
but the following is a fair statement of what I have observed. My 
patients were, with the exception of a majority of those suffering 
from phthisis, nearly all children. I have had not less than a hun- 
dred cases of acute bronchitis, nearly all of which ran a milder and 
shorter course than similar cases do in Philadelphia. The majority 
of these cases had during treatment the best possible hygienic sur- 
roundings, but a few which were much exposed during cool, rainy 
weather in leaky, damp apartments, seemed to do equally well. A 
few, perhaps ten, cases of subacute bronchitis, which had remained 
stationary in the city for some time, rapidly recovered at the sea- 
shore. Three or four cases of chronic bronchitis, with emphysema 
and occasional severe attacks of asthma, greatly improved ; but 
about an equal number showed no change. Two or three cases of 
tardy convalescence from pneumonia made much more rapid pro- 
gress towards recovery after their removal to the seashore. Two 
cases of empyema with external fistulse greatly improved. About 



IS 

twenty cases of phthisis have been under my care at Atlantic City. 
These have been in all stages of the disease. A very few, I recall 
but three, derived no benefit ; all the others improved in general 
health. In some, even of the advanced cases, the improvement was 
marked. In many of the cases the cough became less troublesome 
and the breathing less labored. Nearly all slept better. Hectic 
frequently disappeared entirely, or was greatly lessened. These 
cases, with two exceptions, remained too short a time to allow of 
any inference in regarci to the effect of their stay upon the progress 
of the disease itself. One of these two exceptional cases remamed 
three months. It was one of the few that did not improve at all, 
and the disease ran its usual course. The other spent most of the 
time during the last eighteen months of his life at Atlantic City, 
and his downward progress was undoubtedly much retarded by so 
doing. I am aware that the experience which I have thus detailed 
has been too meagre, except perhaps in the cases of acute bronchitis, 
to allow of any general conclusions. But, after comparing my own 
experience with that of others, I am convinced that the atmosphere 
of Atlantic City in summer (perhaps also in winter, but I do not 
know) will prove especially beneficial in the large majority of cases 
of diseases of the respiratory organs, and that the very common 
opinion that the sea-coast is everywhere unsuitable for cases of 
phthisis has little foundation. So thoroughly am I convinced of 
this fact that I am striving to have special provision made m the 
Seaside House for Invalid Women for consumptives, and m doing 
so I 'am but following in a small way the example set by the 
establishment of the magnificent Royal National Hospital for 
Consumption on the sea-coast of the Isle of Wight.' 

"The good accomplished by this climate I attribute not to any 
specific influence of the air upon the lungs, but to its tonic and al- 
terative properties, acting by the improvement of digestion and 
nutrition, the promotion of sleep, &c. Atlantic City is the most 
accessible to the New England and Middle States of any place hav- 
ing claims as a winter resort and admitting of out-door exercise for 
most invalids the whole winter through." 

A DRY AND BRACING CLIMATE. 

Dr William Pepper's report of his experience in sending patients 
to Atlantic City was not received until after the publication of the 
above article. It is emphatic testimony from a recognized authority 
in pulmonary diseases, and is therefore given a place here :— 

"Philadelphia, i8ii Spruce Street. 

"My Dear Doctor Reed:— In reply to your question as to my 
experience with the climate of Atlantic City in cases of diseases of 
the chest, I would make the following remarks : — 

" I am more strongly convinced each year of the advantage m 
the treatment of such cases possessed by dry, bracing climates as 



i6 

compared with moist, sedative climates. Undoubtedly there are 
certain special types of disease that do better in the latter, but it 
has seemed to me that the benefit derived amounts to palliation or 
relief, and not to radical cure. One difficulty attaching to the re- 
sidence of invalids in dry, bracing climates is the fact that a far 
greater degree of attention to personal hygiene and systematic re- 
gimen is required. There are fewer risks of renewed congestions 
or increased catarrhs in a moist sedative climate, it is true ; but on 
the other hand, if the patient is carefully instructed by his medical 
adviser as to the proper mode of living in a dry, bracing climate, 
and is willing to faithfully attend to all the details of such instruc- 
tions, there is in my judgment a far higher degree of actual, perma- 
nent benefit to be secured in the great majority of cases. 

"This applies especially to patients who are still in the curable 
stage of consumption, for in a large proportion of cases of phthisis 
there is an early stage when no true tuberculous disease exists, and 
when a cure is possible under the combined influence of suitable 
climate, rigidly careful hygiene, and judicious medical treatment. 

"I would further say that I have seen enough of the results of 
the climate at Atlantic City to satisfy me that it acts powerfully in 
most cases as a dry and bracing climate. Many cases of incipient 
phthisis, and even of phthisis in the second stage, have been greatly 
and permanently benefited by a residence there under a strict rule 
of living and treatment. In several cases of chronic pleurisy with 
marked atony of the skin and system, and retarded absorption of 
the morbid products, I have seen the removal to Atlantic City soon 
followed by rapid improvement. I am referring to this climate as 
I have observed it at all seasons of the year. And in respect par- 
ticularly to that which I have just mentioned, the element of relaxa- 
tion of the skin, which is common to so many diseases and is so 
powerfully conducive to renewed attacks of congestion or inflam- 
mation, I have observed excellent results from the stimulating dry 
air of Atlantic City. 

"In retarded convalescence from acute diseases, and in conditions 
of impaired nervous tone, I have also found its climate very valuable. 
On the other hand, in the majority of cases of organic heart disease 
and of bronchial asthma, the results of residence at Atlantic City 
have not been favorable. 

" It is unquestionably an admirable climate, and I am convinced 
that if those who resort to it would but observe with sufficient pa- 
tience and minuteness the necessary precautions, they would for 
the most part avoid the bad effects that some have experienced, and 
would find it highly beneficial in the conditions I have above men- 
tioned, as well as in others to which I have not time to allude. 
" Yours verv truly, 

"WILLIAM PEPPER. 
"Dr. Boardman Reed, 

Atlantic City, N. /.'' 



17 

My experience as a resident physician coincides in the main per- 
fectly with that of Dr. Pepper as above recorded ; but with regard 
to asthma, it has happened to me to see a majority of cases do well 
at Atlantic City, though with some few the climate has manifestly 
disagreed. One prominent railroad man who suffers much from 
asthma when inland, spent the whole of last winter here with entire 
relief. 

FURTHER ADVANTAGES OF ATLANTIC CITY AS A 
SANITARIUM. 

Certain partisans of Florida and Minnesota last winter engaged 
in a spirited controversy concerning the merits of those regions 
respectively, as resorts for consumptives in winter. Since these 
climatic extremes were each setting forth its claims so earnestly 
in the New York Medical yournal, it occurred to the writer that 
the many marked advantages of Atlantic City ought to be placed 
before the readers of the same publication. Hence an article enti- 
tled "What Atlantic City can do for Consumptives," was pre- 
pared and appeared in the number for March, 1881. The fol- 
lowing portions are deemed worthy of being reproduced in this 
pamphlet : — 

•' It does not seem necessary to decide in favor of either Florida 
or Minnesota — the extreme south or extreme north — as the only 
proper residence for such patients in the winter season. Professor 
Bennett in his work on 'Pulmonary Consumption,' expresses a 
sentiment on this point, which, though Dr. Kenworthy has quoted 
it, appears scarcely to help his case. It is this : ' Now that medical 
doctrines have changed, that vitalistic and sthenic views of treat- 
ment prevail, and are found to give infinitely more satisfactory re- 
sults than those that followed antiphlogistic treatment, the medical 
mind in America and Europe looks about for a colder climate. As 
usual, the pendulum has a tendency to pass to the other extreme ; 
to go from Madeira, Jamaica, and Barbadoes, from Havana, Florida, 
and Nassau, to the ice-covered summits of the Swiss mountains, to 
the frozen plains of Northern America. Many minds can never con- 
stitutionally accept and follow the golden adage, ''Medio tutissimus 
ibis ;'' they can not remain in the middle of the road; they must 
pass from one extreme to the other. ' 

" Evidently Professor Bennett considers Florida and Minnesota 
as extremes, and would give the preference to some middle region. 
Atlantic City, N. J., situated in latitude 39° 22', is just about mid- 
way between the peninsula of Florida and the ' frozen plains of 
Northern America,' and may therefore claim to be the ' golden 
mean.' It is rapidly growing in favor as a winter resort for many 
classes of invalids. It has one of the driest and most equable 



i8 

climates on the coast, has better hotel accommodations than can be 
found in either Florida or Minnesota, and is so accessible to the 
New England and Middle States that a trip hither is neither a seri- 
ous undertaking nor a finality involving a complete cutting adrift 
from home, friends, and physicians, with the prospect of dying 
among strangers if the climate should not suit. 

" There are many patients who are drifting into phthisis as the 
result of a general break-down following excessive devotion to busi- 
ness or pleasure. These may not care and do not need, to expa- 
triate themselves for half the year. They may often do perfectly 
well at home, provided they avoid all excesses and have the best 
possible medical treatment ; but, their vital forces being at a low 
ebb, they need occasionally the stimulus to be derived from a few 
weeks' sojourn in some invigorating seaside climate, where it is not 
so cold as to keep them in-doors, and yet not so warm as to relax 
their tissues and still further debilitate them. It is this class of 
phthisical cases, and numerous other affections resulting from ner- 
vous exhaustion, that we see most of here, and find to receive most 
of the benefit from the climate. 

"Through the courtesy of Sergeant E. B. Garriott, the observer 
in charge of the signal station in New York, some statistics of the 
weather in that city during the three spring months of the year 
1880 have been obtained, and in the following table are compared 
with the corresponding figures for Atlantic City, furnished by the 
observer here : — 



Mean Rainfall Mean 

March, 1880. Temperature. in Inches. Barometer. 

New York City 34.0 4.66 30-065 

Atlantic City, 40.1 5.97 30.061 

ApiHl, 1880. 

New York City, 49.0 3.38 30-015 

Atlantic City, 49.3 1. 83 30.045 

May, 1S80. 

New York City, 65.0 0.82 30.059 

Atlantic City, 63. 1 0.54 30.088 

" From this table it will be seen that the temperature during March 
averaged six degrees higher here than in New York City ; in April 
it was only slightly higher ; and in May, when New York began to 
experience its foretaste of the summer heats, it averaged cooler in 
Atlantic City. The rainfall was less here in April and May, though 
a little greater during March, than in New York. 

" During the entire year ended June 30th, 1879, the amount of 
rainfall in New York was 43.68 inches, as against only 40.6 inches 
at Atlantic City. Taking a series of years, the rainfall in New 
York City is found to average only a little more than at Atlantic 



19 

City, though greatly less than at most seaside stations. For in- 
stance, during the two years ended June 30th, 1879, thci'e were 
135.02 inches of rainfall at Wilmington, N. C, 108.04 inches at 
Newport, R. I., 103.73 inches at Jacksonville, Fla., 86.36 inches 
at New York, and only 83.5 inches at Atlantic City. 

"If it were desirable to prolong this article, I could cite numer- 
ous cases of consumption which have been markedly benefited by 
a winter's residence here. I can recall several persons who came 
here a few years ago with chronic cough and evidences of consoli- 
dation in part of one lung, and, having experienced decided im- 
provement, have remained ever since, winter and summer. The 
disease in these cases seems to be arrested. The majority of such 
patients here are from Philadelphia and Pennsylvania, but within 
the last two or three years I have seen many consumptives from 
New York, as well as from Boston and other cities of New England. 
Some who came in the last stage found no benefit, but nearly all 
who have come while the disease was yet in an early stage, or, if 
further progressed, was pursuing a slow and chronic course, gained, 
at least, for a time. 

" One notable case is that of a New York merchant who spent 
last winter here. After having had several hemorrhages and be- 
come considerably emaciated, he came here early in November, 
with instructions from his physicians to proceed farther south as 
soon as the weather grew too cold for him. He remained all winter, 
walking out almost daily, and returned to New York in the spring 
to resume his business, greatly improved in health. 

"Atlantic City offers, then, as its chief advantages for winter 
residence, a pleasant and highly remedial climate and great accessi- 
bility. But a place where invalids accustomed to the usual com- 
forts, luxuries, and social enjoyments ot civilization are expected 
to reside for months at a time, must possess other attractions be- 
sides a good climate and accessibility, else ejinui and home-sick- 
ness would soon more than counteract the exhilarating effects of 
the air, and then the more numerous the railroads, the quicker an 
escape would be made. 

"Atlantic City is now one of the largest of the distinctively sea- 
side towns in the United States, having a permanent population of 
six thousand. It has church services conducted all the year, accord- 
ing to the Episcopal, Catholic, Presbyterian, Methodist, and Bap- 
tist forms of worship, with the usual social organizations of these 
different denominations. The place also boasts of street railways, 
omnibus lines, and no lack of carriages and phaetons for hire at all 
seasons j good fishing and shooting ; circulating libraries ; hot and 
cold sea-water baths; and finally, excellent hotels, at some of 
which, during the latter part of the winter, there is to be found as 
choice and brilliant a society as at the height of the summer 
season." 



HYGIENIC HINTS AND SANITARY PRECAUTIONS, 

In an article contributed to the Philadelphia Medical Bulletin, 
for November, 1880, the writer thus alluded to some important hy- 
gienic considerations : — 

" The matter of diet here is not so important in winter as in sum- 
mer. Errors in this respect are not then apt to be followed by such 
serious consequences. But it is safe to counsel all invalids to re- 
strain the prodigious appetite they are almost sure to acquire soon 
after coming. Otherwise, constipation, headaches, and loss of appe- 
tite eventually result, showing that an overloaded stomach and em- 
barrassed liver have struck work. 

"It is a mistake to suppose that one can not take cold at the sea- 
shore. 

" It is necessary, then, that invalids here should take the usual 
precautions against being chilled. In the winter season, and on 
summer evenings, wraps of some kind are always in order, out of 
doors, though usually they need not be heavy. 

"As to exercise, while some is needed by the weakest invalids, 
even though only of a passive kind, such as massage by a manipula- 
tor, or rubbing by an ordinary attendant after the bath, there is com- 
monly little danger that those able to walk shall not get enough. 
Many are inclined to take too much, owing to the extraordinary 
stimulant effects of the air, and need to be restrained, lest they ex- 
haust their small stock of vitality as fast as it can be replenished. 
But this tendency is far less in winter than in summer, when the 
nightly hops and other multitudinous pleasures and dissipations keep 
the more impressionable visitors in a constant whirl of feverish ex- 
citement. 

"There is, at this season, a restful air about not only the select 
cottage boarding-houses, but also the largest hotels, even when 
crowded as they are in February and March with the elite of the 
great cities. The tired brain-workers and exhausted devotees of 
fashion, equally with the convalescents and more chronic invalids, 
having come to rest and recuperate, go about it, generally, in a quiet, 
sensible way. 

" One word, finally, as to medicinal treatment. For some cases 
the air alone is sufficient. Others get on famously with the air and 
the help of judicious bathing. Still others need medicines, and lose 
by having them stopped during their stay at the seashore. For these 
last, the tonic and alterative virtues of the air often furnish just the 
adjuvants necessary to accomplish the cure. The medicines which 
at home were nugatory or only half successful may succeed perfectly 
with the aid of the sea-air, when neither, alone, would be sufficient." 



The following, with regard to the sanitary condition of Atlantic 
City, is from an article contributed by the writer to the Philadelphia 
Medical and Surgical Reporter of July 9th, 1881 : — 

"The sandy beaches on the New Jersey coast are generally free 
from malaria, except at points where freshwater streams empty into 
the ocean. Professor Alfred L. Loomis, of New York, in a recent 
lecture, discussed the subject of malaria with his accustomed abil- 
ity. He said : 'Salt-water marshes are, as a rule, especially free from 
malaria ; but mix salt and fresh water, as on some of the New Jer- 
sey marshes, and you have the conditions for generating the poison. 
Marshes that rest on a substratum of sand are not so malarial as 
those that rest on limestone, clay, or mud.' 

"Atlantic City, which, by reason of its rapid growth and promi- 
nence among health resorts, is now attracting to an unusual degree 
the critical attention of sanitarians, is fortunate in being surrounded 
by a plenitude of unmixed salt water, and in being founded upon 
the driest of sand. So far, therefore, as concerns malaria, that 
subtle, intangible poison, which defies alike the microscope and the 
reagents of the chemist, but produces in some unknown way the 
periodical fevers, Atlantic City seems to be highly favored. Inter- 
mittent and remittent are strangers to the regular residents, and it 
is the constant experience of malarial patients coming here that they 
obtain rapid relief with far less medication than at home, often 
especially in the case of children, with no medication at all. 

"Among the important improvements lately effected may be 
mentioned the following : There has been a general filling up of 
lots which were below the city grade. A most stringent contract 
has been made for the removal of garbage, at least once a day, in 
sealed or closely-covered wagons, from every hotel and dwelling- 
house in town, and its transportation by rail back into the country, 
where it is used for fertilizing purposes. All privy wells are re- 
quired to be cleaned at stated intervals, and the contents removed 
in odorless excavators, and these latter appliances are already here 
in use. 

"A few words may be said as to the drainage of Atlantic City. 
There are now eight sewers, which run from the ocean side of Pa- 
cific Avenue across the town and empty into a canal or ditch out 
on the meadows, which in turn empties into Absecon Inlet. This 
would be objectionable if the attempt were made to carry off by 
these sewers any animal refuse, or other offensive matters, such as 
that from water-closets, or even kitchen-slops. Though they have 
a fall of from three to six inches in every one hundred feet, it 
would be impossible for them to remove such substances with suffi- 
cient rapidity and thoroughness ; and even if they could, to pour such 
a quantity of offal into the ocean at our very doors would be most 
undesirable. Therefore, the sewers are used only to drain away the 



ordinary surface water, the refuse matters being removed as above 
described. 

"The system in use here, as now carried out, is beheved to be 
the best attainable on the flat seaside beaches. If any sanitarian 
can suggest a better, the health authorities of Atlantic City would 
be pleased to hear from him. 

"Another important consideration at these seaside resorts is the 
drinking water. At many places the surface water obtained by 
digging a few feet in the sand is habitually used for drinking and 
culinary purposes. This is decidedly unsafe. Intestinal fluxes, 
and even typhoid fever, may be produced in susceptible persons by 
using such water. The hotels, boarding-houses and cottages in At- 
lantic City are supplied with cemented cisterns or wooden tanks 
for collecting rain water, and either the latter or melted ice is al- 
ways obtainable." 

Under the head of hygiene very much more might profitably 
be said, since many invalids fail to improve here as they ought, 
solely because of neglecting little precautions which, though ap- 
parently trivial, often make just the difference between success and 
failure ; and a whole chapter might well be devoted to the subject 
of salt-water bathing, facilities for obtaining which in-doors are 
now obtainable at all seasons of the year. But this little pamphlet, 
hastily and imperfectly prepared in the hope that it may supply 
a want, has already far outgrown the dimensions originally con- 
templated. 



LIBRftRY OF CONGRESS 



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